Healthcare Provider Details

I. General information

NPI: 1881878049
Provider Name (Legal Business Name): VOLODAR ROMAN KUZYK L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2007
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 W ST RTE 89A STE 114
SEDONA AZ
86336-5445
US

IV. Provider business mailing address

2155 W ST RTE 89A STE 114
SEDONA AZ
86336-5445
US

V. Phone/Fax

Practice location:
  • Phone: 928-239-9706
  • Fax:
Mailing address:
  • Phone: 928-239-9706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13194521-1201
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC-6518
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 6518
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberMED-ACU-LIC-90462
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: